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You might have guessed that I'm talking about the NHS, and it's during an election year that we notice this paradox most of all.
When the parties start publishing their manifestos, you can guarantee that each will contain a strong statement of support for the NHS.
The support will sound convincing. Every day in the NHS, we work hard to maintain the trust that our patients place in us. They in turn want the NHS to thrive, and the parties reflect that.
But all too often politicians make promises as if words alone can improve the NHS. Resources and commitment are vital too. They pledge thousands more GPs, for example, but with no apparent recognition of the growing and unsustainable pressures faced by general practices, and when the numbers entering GP training in England have actually dropped by 15 per cent this year alone.
And after each election, the new minister has the power to make us feel as if we're in a giant snow globe.
A colossal hand reaches for the NHS, and we're being shaken up again with some new laws and organisations.
After the turmoil the snow settles; everything's in a different place, but little has been made better than it was.
The time and endeavour would have been better spent in protecting what we are in danger of losing through starved resources and an obsession with competition and markets.
The NHS is, according to the highly respected Commonwealth Fund, the highest-quality and most cost-effective healthcare system of 11 leading economies, including Germany, France and the US.
And so our many foreign admirers ask the same question: if the system is that good, why do your governments keep playing around with it? For doctors, it's doubly frustrating when there has been so much unnecessary reorganisation, while real opportunities to improve services have been repeatedly passed over.
There is nothing more demoralising than trying to make failed policies work, but doctors have never been a passive or a reactive voice. It's down to all of us to articulate and create an NHS that serves our patients best, in whichever nation we work.
The BMA has already produced its own manifesto for the UK general election and this year we will be building on our existing policy work to create a detailed vision for the future of the NHS in England – an NHS in which change must be evidence-based, clinically led and right for patients.
Reviving our marginalised, fragmented and underfunded public health services will be a major part of this vision. Whoever is in government, we must lobby for every policy to be a health policy. Sir Michael Marmot, a former BMA president, has laid bare the deep and increasing inequalities that shape health outcomes.
Health is devolved to national governments, but there will be many policies enacted at UK level that have a profound effect on our patients' lives. Anything, anywhere, that betters or worsens the health of our patients is our business too.
Only in Westminster does the world begin and end with a general election. Unlike Parliament, our hospitals and GP practices do not go into recess. Patients are always with us, and so too are the issues that affect their care – issues on which we will continue to work before, during and after the election.
Over the past 18 months, we have been trying to agree a new UK junior doctor contract and a new consultant contract for England and Northern Ireland. We negotiated in good faith and were very disappointed when the contract talks stalled.
However, in the absence of credible evidence to underpin proposed changes and for the sake of assuring the safety of both patients and doctors, we could not accept changes to either contract that removed key safeguards against working dangerously long hours. No patient wants to be seen, or should be seen, by a doctor who is too tired to function properly.
The juniors contract for all four UK countries, and the consultant contract for England, Wales and Northern Ireland, have now been referred to the DDRB (Doctors and Dentists Review Body) by the national governments for observations and recommendations.
In the case of Welsh consultants, we think it wholly wrong that the DDRB has been asked to step in given that there have been no prior negotiations between BMA Cymru Wales and the Welsh Government. All the other DDRB referrals follow extensive negotiations.
The DDRB has been given a highly significant role and it must demonstrate its robustness and independence.
For years, despite compelling evidence of declining morale and increasing workload, its recommendations have been very similar to those of the governments. Our real-terms pay has lost value year by year.
This year, we expect the DDRB to test and challenge all the evidence that comes before it. We expect searching questions, and we are able and willing to answer them. This scrutiny should highlight the fact that we were asked to sign on the dotted line with neither a definition of weekend services nor evidence as to the impact on doctors, or your families.
For GPs, it's not so much a case of which party marches into Downing Street as who or what can rescue primary care from an inexorable rise in demand. I'm not even sure that giving GPs the resources they need can be described as a 'political' issue given that their need is utterly beyond controversy.
Another issue with a lasting and potentially negative impact is the Shape of Training report, which could substantially reduce the experience and training that junior doctors acquire before becoming consultants. So much so that the word 'consultant' may not continue to mean what it does now.
The first of the four UK health departments that commissioned the report is likely to give its response early this year. It might not be a big election issue for 2015, but if some of the changes go ahead and patients can no longer access the specialist skills they need, it certainly will be in future elections.
There are 'events, dear boy', as Harold Macmillan famously put it, and then there are the changes in our culture that tend to get missed in a politically noisy year.
Nearly 40 per cent of UK doctors with a licence to practise have already undergone revalidation, and by the end of 2015 this figure is likely to be more than two-thirds. We are less insular as a profession, and we are the better for it.
If the goodwill and energy that doctors have put into the process is to be maintained, it is essential that it should not be burdensome. Sessional GPs are among the doctors who have reported an unsupportive and unrealistic appraisal process. We have published seven principles for a robust and fair revalidation process.
There is little more deeply rooted in our hopes and fears than how and when we die.
This year, we are beginning a major research project, which aims to engage doctors and patients in exploring the practical and ethical issues around end-of-life care and physician-assisted dying.
We are planning a number of events around the UK with the public and doctors, and we hope to compile the most comprehensive body of qualitative research carried out on the subject in the UK.
How people die, and how well they die, are means by which we characterise and judge societies. We are fascinated, and often appalled, by how ancient societies handled it, and we might wonder how our own will be judged.
This is a reminder, although I think only the politicians need one, that it's the government that changes on election day; other changes in society can take a little longer.
Mark Porter is BMA council chair
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